My favorite psychiatrist (after Ben Goldacre of course)- Simon Wessely- just admitted that people with severe mental illness are dying much earlier than they should. However, he fails to see that it is perhaps the gradual poisoning of the vital organs, and damage to the nervous system and brain, from years on the psychiatric drug merry-go round, which is cutting the lives of psychiatric patients short. This (mis) treatment is literally killing psychiatric patients. Has Wessely not seen the state of someone after years on psychiatric medications? I was only on them for 4 years in my twenties and I was in bits afterwards, I literally hobbled like an old man at 25, had muscle spasms and I looked and felt like crap. It took me years to recover after the horrors of Seroxat but I am so thankful that I came of it when I did, I can only imagine how messed up I would be had I stayed on it and not gotten away from the psychiatric system. Sadly, I have met people who have been on these drugs for decades and I can say with all honesty that these people were utterly destroyed from psych meds. One friend of mine was prescribed Seroxat for 15 years, can you imagine that? He lost his hair, he became a virtual recluse, agoraphobic, he became infertile, lost his sex drive and had long term emotional blunting and anhedonia for years after, he will never ever be well again. Another former co-worker of mine was under psychiatic care for years, in and out of psych wards with various diagnoses and cocktails of drugs, she was prescribed the dreaded Zypexa. The last time I saw her I didn’t recognize her, such was the state that horrid drug left her in- she had tardive dyskenesia (basically her neurons were fried from it). Her weight had increased dramatically. Her tongue would dart in and out of her mouth like a lizard and she looked like death. She will never be well again. Long term psych drug users end up drooling messes and shells of their former selves, some of them end up brain damaged from the drugs (particularly the anti-psychotics). Robert Whitaker covered all this in his groundbreaking book , ‘an anatomy of an epidemic’, has Wessely not read this important book?
The mind boggles..
For more hilarious Wesselyisms see the full interview here:
We need shrinks in hospital emergency rooms
It’s time to abandon mind-body duality in medicine: we need psychiatrists in hospitals and better physical care for psychiatric patients, says Simon Wessely
Why do you think psychiatry needs to be better integrated with general medicine?
In the UK, psychiatrists tend to work out of separate mental health hospitals. If the goal were to split physical and mental health, the National Health Service could not be organised better. Yet most illnesses are not so easily divided. And the evidence that psychological treatments can have an impact on physical disorders is growing.
Could you give an example?
Take heart attacks. What could be more perfectly physical? But depression actually has a greater influence than smoking on your chances of surviving the following 12 months. Also, in cardiac clinics, many people come in with what looks like heart disease but turns out to be panic attacks.
So what needs to change?
We need liaison psychiatrists, which basically means you have an embassy of psychiatry in the middle of the acute general hospital. It deals with all the kinds of psychological and social problems associated with a busy hospital: depression in people with cancer, for instance, dementia in old people or problems in the accident and emergency department (A&E).
We’re putting better psychiatric services in at King’s, but we also want to get more physical care to those on the other side of the road, because we know that people with severe mental illness are dying much earlier than they should.
Are you optimistic this can happen?
Things are already changing. The number of liaison psychiatrists is increasing and junior doctors are getting more training in psychiatry. But we still need to do more to bring psychiatry into the heart of medicine, where it belongs.
This article appeared in print under the headline “Psychiatrists on standby”
Simon Wessely is a psychiatrist at the Maudsley Hospital in London and the new president of the Royal College of Psychiatrists. He has spent most of his career highlighting psychological influences on physical health
Before the internet/digital age, historically powerful and influential institutions and corporations, had more or less complete dominance over the spread of information, and also how that information was shared, filtered, disseminated and interpreted. The discourse around that information, and knowledge, was invariably generated and shaped by elite organizations, powerful news media, the agenda of government and big business etc. In the past 15 years, with the advent of the internet, and subsequently, the development of a world wide digital social media apparatus (which includes Facebook, blogs, twitter etc), the traditional landscape of how (previously controlled) information, ideas and ‘messages’ circulated is now completely subverted. Nowadays, we have something of a more level, democratic, and ‘fairer’ playing field in regards to access to infinite streams of information. Easy access to sophisticated digital tools -which previous generations could only dream of- have (for better or worse) brought us all together in an online interconnected universe.
Some people don’t like this new democratic system. They haven’t quite come to terms with the reality that the world wide web has given every individual access to the online discourse; a digital universe where ideas and opinions can flow freely. An online space where a tweet can become an international news-worthy talking point, or where a lone blogger can have a global presence. People don’t take information at face-value anymore, they research it themselves online, they ‘google it’, ‘google it’ again and ‘google it’ some more until they find what they are looking for. In this new online digital world anyone with an internet connection can challenge established dogmas, ideologies and systems that they disagree with. The world of information and knowledge is no longer filtered through traditionally narrow channels. Knowledge is no longer under the control of the few. In this new world- dissent from twitter, youtube and Facebook can aid revolutions in the middle east (like the arab spring) or help websites advocate transparency for our governments and hold them to account (WikiLeaks).
Anyone can set up a twitter account, or create a blog, and anybody can engage with the new digital discourse. We can all debate each others views, challenge prejudice and ignorance, and have our own views challenged too, and hopefully help make the world a fairer, more democratic place to live. This is surely good for society, the evolution of culture, and mankind in general isn’t it?
I created this blog several years ago, because I was prescribed a dangerous, defective drug called Seroxat for depression in my twenties and I wanted to warn others of the possible dangers of SSRI anti-depressants and the perils of psychiatric diagnoses. I should have received talk-therapy at the time, and I would have been fine, but such is the mental health system that I was not provided with an option apart from drugs. Psychiatric drugs are highly profitable and psychiatry is only too eager to put us all on them. The drug company, GSK, hid the side effects of addiction, severe withdrawal, aggression and other side effects in order to make a profit (dead patients from dodgy drugs aren’t good advertising for business). Suffice to say, after finding this fraud out, I became a little pissed off. As you would …
After a long and arduous withdrawal, I began (with the magic of the digital internet) to research the drug I was prescribed (Seroxat/Paxil), the drug company who unethically created it (GlaxoSmithKline) and the system (Psychiatry) which allowed this sinister injustice to happen to me. What I discovered on my quest to understand why and how a defective drug like Seroxat comes to market, initially disturbed me greatly. I just couldn’t believe the level of corruption and deception in psychiatry. I was shocked and horrified at the faustian pact between psychiatry and the drug companies. I was disgusted at how psychiatry willingly sold out (and thus sold us- the patients- down the river too), and in the process also sold their monopoly on the human condition to the drugs industry. I was appalled at how doctors ignored patients’ complaints of side effects. I was dismayed and disappointed that the people I thought were there to help me possessed such power to harm me. I was hurt that my vulnerability could be exploited in such a cruel, sadistic and inhumane manner. I realized that we live in a very precarious world, where there are sinister forces that will use, abuse, and exploit your vulnerability for monetary gain or to maintain the status quo, or their own status. I learned that drug companies are callous and that psychiatry (like the Catholic church) is in deep denial. I learned that many people are being harmed by both, and grave injustices to vulnerable people continues, but in this blogging mis-adventure, most importantly- I discovered that there are others who share my views, and that online, those views can be heard.
Undoubtedly, some psychiatrists will dismiss me and my blog, as ‘anti-psychiatry’. This is a mere semantic charade. It’s a trick which psychiatry tries to use when people like me (ex- psychiatric service users) educate ourselves, begin to speak out, and in the process challenge their dogma, and quite often we ruffle a few feathers too! I am not anti-psychiatry, I am anti-psychiatric deception, misinformation and lies. I am pro-patient, and anti- psychiatric harm. If anything, most critics of psychiatry that I know of- lean more towards the hope of psychiatric ‘reform’ than the complete destruction of the profession. Most of us just want to be heard.
Psychiatry deeply needs to reform and it needs to engage with its critics, but (like that other arrogant ideological dogma -the Catholic church) it is extremely stubborn and it treats criticism as threats (and critical voices as flames- which need to be stamped out). Until psychiatry learns to adapt to criticism, particularly from ex-service users, it will continue to be seen as aloof, cold and devoid of compassion. Psychiatric reaction to criticism often has the opposite effect, instead of shutting us down, and quelling debate and dissent, some people damaged by psychiatric drugs shout louder. Oftentimes, people don’t appreciate being condescended to or having their experience debased and invalidated, particularly from the very regime that did the damage. Mainstream psychiatry’s reaction to criticism from service users, or those unhappy with drug treatments, is comparable to how the Catholic church reacted to abuse victims. It’s understandable that psychiatry would be intensely defensive, but that doesn’t justify it.
That last point- brings me finally- to Psychiatrist Simon Wessely. Over the past few weeks I have written a few critical blog posts on Simon Wessely; highlighting some things which I feel need to be highlighted. I wrote these posts mainly because I have a highly critical eye- and a critical ear. Therefore, when I hear or read misnomers, misinformation, red herrings and inaccuracies in the current mental health discourse, I feel the (democratic) need to challenge and to express my opinion on it. I feel, as a former psychiatric service user, and a former psychiatric drug user, that I have a valid and legitimate voice in this arena… but evidently some don’t feel the same.
Simon is an extremely influential psychiatrist. He has access to massive news dissemination networks like the BBC, The Guardian etc. Simon has the backing of powerful organizations, with governmental contacts, and political sway. I am just an independent mental health activist, a nobody, with a small blog and a small twitter presence, how could anything I draw attention to be of any significance to someone with such a large and powerful influence?
Simon sent me an e-mail recently, but because he stated boldly that it was a –
“PRIVATE E MAIL’
I am hesitant (out of mere common courtesy) to post it in its entirety,
However, I will publicly respond to Wessely here on my blog, as to be honest, I feel I have a right to express my response whatever way I see fit (it is the 21st century digital age after all).
I understand completely why you decided to block me on twitter, however I will not block you as I believe in a democratic, adult discourse about psychiatry and psychiatric drugs. I know my questions must have bothered you, as I’m sure you don’t often take it upon yourself to e-mail ex-psychiatric service users who disagree with much of your views. However, I do find it ridiculous when you say that you ‘don’t find the possibility of a meaningful discussion’ with me because you have not in any way even attempted to engage with anything I have to say on my blog, or on twitter. Therefore, any chance of a meaningful discussion has been nil from the beginning.
I am anonymous because I choose to be, and also because the issues I raise evidently can sometimes cause some controversy. You are a public figure firmly connected (and protected) by the establishment which you represent, I am not. I am an accidental mental health activist, I get no accolades, awards or pay for my work. There are over 650 blog posts on this blog, most pertaining to corruption and fraud within your profession and the pharmaceutical industry (an entity which props up your profession). If you should care to read some of them, particularly the ones on Seroxat, you might gain an insight into what I do and why I do it.
I have questioned some aspects of interviews, and views you have expressed, in mainstream media outlets such as BBC Radio 4 and The Guardian, and I feel I have a democratic right to do so, particularly when I feel that some of the information being disseminated is either wrong, misguided or will cause harm to vulnerable people (by that I mean people suffering from ‘mental health’ issues).
Your views reach huge audiences, mine are modest at best. I could chat all day with you, or discuss endless things about psychiatry, the nefarious influence of the drugs industry, academic bias, cognitive dissonance and ‘mental health’ but you have made it clear that you do not wish to engage at all with me -apart from perhaps sending me ‘PRIVATE e-mails that contain more than a tone and whiff of something ‘veiled’ – therefore Simon I wish you well.
An anonymous ex- psychiatric service user, Seroxat Sufferer, and long time blogger,
(who actually has an education but doesn’t need letters and a litany of statuses after my name in order to stress my importance and superiority)
“…The other thing of course, is it’s not as simple as simply to say this is all the fault of psychiatrists trying to make more money or evil drug companies trying to sell more drugs, both of which, of course are- ya know true– but it’s not the whole story”… (Simon Wessely BBC Radio 4 August 2014)
http://www.bbc.co.uk/programmes/p018qfjm (2hr 35mins)
So what is the whole story Dr Wessely and why do you go on BBC Radio 4, and other media, and not tell people the whole truth about your profession and the drugs you prescribe? Why do you mention ‘treatments’ but fail to illustrate that these treatments are almost always psychiatric drugs with horrendous side effects? Do you not have a conscience? It seems to me that you are a kind of pied piper type character- dispatched from the royal college of psychiatrists to perpetuate the status of psychiatry- to maintain psychiatry’s dominance of the mental health arena- and to recruit potential clients into psychiatric treatments and beliefs.
Or am I wrong? Do anti-depressant’s not have side effects? Are the PIL’s just made up in order to frighten us? (have you seen the length of the Seroxat PIL? It’s practically a novel). Are we all imagining the akathisia, de-personalization, de-realization, cravings for alcohol, zombie-like disinhibition, violent thoughts, violent dreams etc… are those weird things inherent to depression? (I’d be pretty sure that they are not).
When you say (in the article above) that two thirds of Britons are not treated for depression, where does this percentage come from? What study was done in order to generate this fantasy? It seems to me to be quite an arbitrary number because there could be no logical, reasonable or scientific way that you could possibly arrive at that figure. It is an absurd statement because if two thirds of people suffering from depression are not treated, and have never sought treatment, and maybe don’t even identify with being depressed at all, how do you know they exist in those numbers? Why not say half? or three quarters? It seems to me that you just made that figure up in order to get a headline…
Wessely said there would be a public outcry if those who went without treatment were cancer patients rather than people with mental health problems. Imagine, he told the Guardian, the reaction if he gave a talk that began: “‘So, we have a problem in cancer service at the moment. Only 30% of people with cancer are getting treatment, so 70% of them don’t get any treatment for their cancer at all and it’s not even recognised.”
Why are you comparing depression to cancer, not only is this a bad analogy (depression is nothing like cancer, it’s an emotion not a disease) but it’s also scare-mongering (although of course more people go for treatment, psychiatry gets legitimized, and psychiatry makes money and that’s what’s really happening here).
People like you are very dangerous Dr Wessely because you are more concerned with promoting the ideological paradigm of psychiatry than anything else..
You’ll deny (or fail to mention) side effects and ignore patients bad experience of psych meds because it simply doesn’t fit in with how you want psychiatry to be perceived… and you’ll do this blatantly, without shame, on national radio stations, because you are really that arrogant…
It’s simply abhorrent, your statements lead to damaging the mental and physical health of patients, and the meds you espouse destroy lives.. people become trapped in the system and get drugged to death eventually, lifelong customers, or mis-diagnosis after misdiagnosis, ending up on the psychiatric merry go round, never getting better, always getting worse…
But all these medicated, confused and disempowered patients gives loads of fodder for the psychiatric system though doesn’t it?.. More money in the coffers… keep the system rolling..
How much do you get paid to sprout this dangerous, hysterical, misleading nonsense anyhow?…
Whatever it is Simon- it’s way too much!
Professor Simon Wessely, who was recently installed as President of Britain’s Royal College of Psychiatrists, has just written his second post in that capacity. It’s called Happiness: The Greatest Gift That I Possess?
The background to Dr. Wessely’s article is the recent launching of the UK’s Centre Forum’s Mental Health Commission’s report: The Pursuit of Happiness: a New Ambition for our Mental Health. This is a very interesting report, the gist of which can perhaps be gained from these quotes:
“The pursuit of happiness should be a goal of government.”
“Mental health problems are the biggest contributor to poor wellbeing.”
“The national curriculum should include the requirement to teach children and young people how to look after their mental health and build emotional resilience through approaches such as mindfulness.”
“A dedicated mental health minister in the Department of Health should be created with responsibility for mental health services and a Cabinet level Minister for Wellbeing reporting to the Prime Minister should be appointed.”
“Every Health and Wellbeing Board (HWB) should appoint a Wellbeing Champion to advocate parity of esteem between mental and physical health and promote wellbeing.”
“Good mental health and wellbeing policy is simply good health policy, and investment in this new ambition would do more to reduce the human and financial costs of misery and mental health problems. Investment in this ambition could work towards the following achievements:
- Reduce poverty and social disadvantage;
- Promote human rights and inclusion;
- Reduce the human impact of mental health problems;
- Prevent premature death;
- Reduce the economic costs to society;
- Put knowledge of cost-effective treatments into practice.”
The report is interesting in that it appears to be trying to walk a line between psychiatry’s standard cry for more treatment for “mentally ill” individuals on the one hand, and the development of more general strategies for alleviating inequality, promoting competence etc., on the other. The term“mental illness” occurs 19 times; while the term “mental health problem” occurs 91 times. I may be over-reading this, but I did get the impression that the Commission is endorsing the illness doctrine with regards to the conditions labeled schizophrenia, bipolar disorder, and major depression, but rejecting, or at least not endorsing, the doctrine with regards to the other psychiatric “diagnoses.”
In any event, they are recommending that efforts to alleviate mental health problems be expanded to include methods other than psychiatric drugs, electric shock, etc . . .
Dr. Wessely’s reaction to all of this was interesting.
“At the same time public mental health is also being included in a wider social issue – the current debate loosely around what we might call the ‘wellbeing agenda’. Few people, and probably no members of this College, can, or will, deny the importance of strong communities, families and relationships, to name but three, to our general sense of well being. But in my opinion we need to be a little more cautious about mixing public mental health with this ‘dash for happiness’ – and its various facets such as positive psychology, well being and optimism.”
But his enthusiasm is not total.
“But as an academic psychiatrist with a major interest in population approaches, I am not yet convinced that this will do something significant about reducing the burden of morbidity that we deal with – for example disorders ranging from major depression, phobic disorders, OCD, autism, schizophrenia and so on and so forth. The evidence for this is slender . . .”
In other words, public promotion of happiness and wellbeing won’t alleviate psychiatric illness. Only psychiatrists can do that.
“Ideally we could do both. Support what we traditionally do, and what our patients expect from us, whilst at the same time also lending our support to the broader agendas that are now being looked at by all three political parties. Unfortunately as we all know ‘there is no more money’. And my worry is that the money for the experimental interventions, which is what they are, will come from our own budgets. I have noticed that is often the case – something that is new, buzzy, smart and promises much tends to be more attractive precisely because it is innovative, and will take resources from what is seen as ‘conventional’.”
On the one hand, Dr. Wessely points out that there is little evidence for the efficacy of the happiness/wellbeing agenda, but ignores the fact that the evidence for the efficacy of psychiatric treatment is based almost entirely on short-term, interest-conflicted, pharma-funded trials. He also seems to have forgotten that it isn’t all that long ago that psychiatric drug treatment was “new, buzzy, smart,” and promised much, and incidentally, hasn’t lived up to its promises.
” . . . you can come at this from the other direction i.e. that by treating their mental illness, patients will inevitably become happier as their suffering is alleviated. And I certainly can’t argue with that.”
The word “inevitably” strikes me as grandiose. What of the people who have been so damaged by SSRI’s that they are virtually incapable of feeling normal joy? What of those people whose lives have been destroyed by neuroleptic-induced tardive dyskinesia and akathisia? What of the people whose lives have been ruined by benzodiazepine withdrawals? What of the victims of electric shock treatment who can’t remember that they went to college and got a degree? The notion that “psychiatric treatment of mental illness” will inevitably make people happier is the very height of psychiatric arrogance. In my experience, the only inevitable outcome from long-term psychiatric treatment is significant to profound organic damage, coupled with disempowerment and stigmatization.
“So if we have to make choices, we should remain on the side of patients, carers and the evidence. It’s a difficult balancing act, one that confronts all the three main political parties as they prepare their health manifestos. In the meantime, let’s pursue happiness, but equally let’s not expect that happiness alone will deal with the problem of mental disorder.”
There it is again: this happiness stuff is peripheral; our “patients” are sick, and they need us psychiatrists to “treat” them. It’s the same old song.
. . . . . . . . . . . . . . . .
Early in the article, Dr. Wessely stresses the magnitude of the “mental disorder” problem.
“Mental health is an important public health issue . . . since mental disorder is responsible for an astonishing 23.6% of the years lost to disability in the UK – the second largest cause behind musculoskeletal disorders . . . Such a large burden of mental disorder is due to a combination of high prevalence, early onset in the life course, and broad range of impacts including in public health related areas. These impacts result in an annual cost to the English economy alone of £105 billion . . . and, looking further afield, annual global costs of US$2.5 trillion . . . and €532.2 billion in the European Union . . . Vastly more importantly, this represents a wealth of human suffering.”
Psychiatrists and psychiatric associations have been quoting these kinds of statistics increasingly in recent years, and tragically they are being picked up and promoted unquestioningly by politicians and by the media. But let’s take a closer look:
” . . . mental disorder is responsible for an astonishing 23.6% of the years lost to disability in the UK . . . “
In this context, depression is often cited as one of the “illnesses” that contributes to occupational absenteeism. And depression, of course, is a fact of life. We all have our ups and downs. But psychiatrists insist that what they mean by major depression, dysthymia, etc., is not the ordinary ups and downs – but depression-the-illness, which they contend is something radically different.
So the question naturally rises, how do we distinguish between ordinary feeling down, on the one hand, and depression-the-illness on the other. Psychiatry’s answer is that depression-the-illness causes ” . . . clinically significant distress or impairment in social, occupational, or other important areas of functioning.”
This phrase occurs as a criterion feature in almost all psychiatric “diagnoses,” and is embodied in the DSM definition of a mental disorder, but is unsatisfactory from a number of aspects. Firstly, the term “clinically” has no meaning, other than a thinly-veiled attempt to lend a medical flavor to the phrase. Secondly, the term “significant” is not defined, and inevitably rests on the subjective opinion of a psychiatrist, who, in many cases, has a vested interest in “finding” a “diagnosis.” Thirdly, the term “impairment” suggests an inability of the individual to engage in the activity in question, when in fact, the only information that is usually to hand is that the individual hasn’t actually engaged in the activity. Fourthly, the phrase asserts that the causal sequence runs from the “disorder” to the activity (the depression, for instance, causes the person to miss work), when in fact the opposite sequence is just as plausible (missing work causes depression).
But with regards to Dr. Wessely’s statement, there’s an even more serious problem. At any given time, a certain percentage of the population will be experiencing some measure of depression. (Even this isn’t quite accurate, in that depression-joy is a continuum with no sharp cut-offs; but let’s set that consideration aside.) Let’s say that the proportion of people experiencing depression is 10%.
According to psychiatry, a sub-group of these individuals have depression-the-illness. The criterionby which a person gets from the first group to the second group is the clinically-significant-distress-or-impairment standard cited above. One way – and I suggest the major way – of meeting this standard is absence from work. So, a person who is depressed, according to psychiatry, is not necessarily mentally ill, but if he’s depressed and missing work, then he crosses the threshold, andis mentally ill.
So, psychiatry posits absence from work as one of the major criteria for mental illness, and then “discovers” the astonishing fact that mental illness causes (“is responsible for”) a great deal of work absenteeism!
But Dr. Wessely takes the nonsense further. Not only is he blind to his own circular reasoning, he actually goes on to tell us why mental disorders impose such a burden of economic loss and human suffering.
“Such a large burden of mental disorder is due to a combination of high prevalence, early onset in the life course, and broad range of impacts including in public health related areas.” [Emphasis added]
It is not because of high prevalence, early onset, and broad range of impacts that the so-called mental disorders constitute such an economic burden. Rather, it is because of the way psychiatry defines them. When psychiatrists assert that depression-the-illness causes a great deal of missed work, the essential meaning of this statement is that workplace absenteeism is caused by people missing work. This is not quantum physics. It is logic 101.
Yet psychiatry remains routinely and resolutely blind to its specious assertions in these areas, and continues to disseminate these “burden-of-disease” figures as a justification for their continued existence. This is emphatically not because psychiatrists are inherently stupid. Rather, it is becausethe primary agenda of psychiatry is the promotion of psychiatry, and Dr. Wessely is staying firmly in this role in his new position.
It occurs to me that the title of Dr. Wessely’s article may be lost on some – particularly younger – readers. In 1963, Bill Anderson, an American country singer, wrote and recorded a song called “Happiness,” the first line of which is the title of Dr. Wessely’s article. It’s a pleasant song with a catchy tune, but it didn’t do particularly well. But in 1964, the British singer/comedian Ken Dodd recorded it, and it took off. The theme of the song is that the best things in life are free. Here’s a quote:
“Happiness to me is a field of grain
Lifting its face in the falling rain
I see it in the sunshine, I breathe it in the air
Happiness, happiness everywhere”
Which strikes me as being a far cry from psychiatry’s notion that virtually all negative feelings can be banished with pills. Ken Dodd is 86, still touring, and apparently still enjoying the simple pleasures. You can see a much younger Ken singing “Happiness” here, with the late Freddie Mercury singing along (kind of). But I must warn you: if you’re the sort of person who gets tunes stuck in your head, don’t open this link!
. . . . . . . . . . . . . . . .
I have no financial ties to Ken Dodd.
http://www.bbc.co.uk/programmes/b047zk6q (scroll to 39 mins: 15 secs)
Sir Simon Charles Wessely is a British psychiatrist. He is Professor of Psychological Medicine at the Institute of Psychiatry, King’s College London and Head of its department of psychological medicine, Vice Dean for Academic Psychiatry, Teaching and Training at the Institute of Psychiatry, as well as Director of the King’s Centre for Military Health Research. He is also honorary Consultant Psychiatrist at King’s College Hospital and the Maudsley Hospital, as well as Civilian Consultant Advisor in Psychiatry to the British Army. He was knighted in the 2013 New Year Honours for services to military healthcare and to psychological medicine. In 2014 he was elected president of the Royal College of Psychiatrists.
(Quite impressive ‘credentials’ you’d have to agree?)
In a recent radio discussion (see above) from the BBC, psychiatrist Simon Wessely complains that anti-depressants are under-prescribed. James Davies (senior lecturer in Psychology) author of ‘cracked’ (why psychiatry is doing more harm than good) disagrees. He points out that most people would favor talking therapy – not pills, that unfortunately the waiting lists often don’t facilitate this option and it is mostly pills that are prescribed for a myriad of different difficulties that people are struggling with. Davies thinks this situation doesn’t help the majority who seek mental health treatment, because he believes mental health problems stem mainly from psycho-social situations (poverty, unemployment etc)…
Despite a very strong argument from Davies, and also the alarming fact that 53 million prescriptions for anti-depressants are written every year in the UK alone– astoundingly- psychiatrist Simon Wessely still remains adamant that depression is under-diagnosed.
In this radio discussion-
James Davies says:
“We need greater transparency and accountability with respect to the financial ties between the pharmaceutical industry and psychiatry”
…”The research does suggest that doctors who receive these payments from industry are more likely to be biased in their clinical activities and beliefs”..
Simon Wessely responds:
‘I’m your worst nightmare here James, because..
I’ve never worked for Pharma’
Why does Simon Wessely say that he has never worked for pharma when according to this 2004 article from medscape (detailing a study of SSRI’s from JAMA and an editorial from Wessely)
“Dr. Wessely has received funding from Pierre Fabry Pharmaceuticals and from Eli Lilly and Co. to attend academic meetings and for speaking engagements.”
Why did Simon Wessely -on BBC radio- say that he has never worked for pharma when he has received funding from Fabry pharmaceuticals and Eli Lilly for academic meetings and speaking engagements? How much ‘funding’ did he receive? And how many ‘meetings’ , ‘speaking engagements’ and so on has he attended over the years? Has the influence of industry skewed Wessely’s views somewhat? Why did he not disclose this?
The SSRI study itself (from 2004) was funded by GlaxoSmithKline :
“This study was funded by the Boston Collaborative Drug Surveillance Program, which in turn received funding from GlaxoSmithKline for consultation by the authors regarding the principles of study design for a possible company study on antidepressants and suicidal behavior.”
Simon Wessely, commenting on the results of the Glaxo-funded study on comparing
“Risk of Suicidal Behavior Similar With Amitriptyline, Fluoxetine, and Paroxetine”
..goes on to say…
“But the hypothesis being tested is that over and above the known association of antidepressant prescribing and suicidal behavior (in which the confounder is the presence of depressive disorder), there is also a specific link in which one class of antidepressants, the SSRIs, increases that risk further. The results do not offer much support for the hypothesis,”
Dr. Wessely writes. “There was no evidence for the alleged withdrawal phenomenon, which is another of the concerns that have been raised about the SSRIs. Stopping medication did not lead to an increased risk, as postulated by some….”
Granted, the study was reported 10 years ago and in that time a lot has changed. We certainly know nowadays that anti-depressants can cause suicide and that Seroxat in particular has an extremely debilitating withdrawal syndrome- but what I would like to know is, does Simon Wessely still think that there is no evidence for the ‘alleged’ withdrawal phenomenon with SSRI’s? Have his opinions changed in light of the last ten years (and more) of evidence? Does he think that paroxetine (Seroxat) is a safe SSRI? How many links does he have to industry? and most importantly- why did he not disclose his links to Pharma (Eil Lilly and Pierre Fabry Pharmaceuticals) in the recent debate on anti-depressants with James Davies on BBC radio?
Why did he say that he has never worked for pharma?
Personally, I think patients with mental (emotional) health difficulties have a right to know which psychiatrists are linked to industry and which ones aren’t because at the end of the day without patients (service users) people like Sir Simon Wessely wouldn’t have careers (and very lucrative ones they are too).
Considering, Wessely is (apparently) closely connected to Ben Goldace and the Sense About Science agenda (of which I and others have written about recently) I won’t hold my breath for any kind of useful response- but discussions, comments and observations are, of course, always welcome…
An alternative perspective on mental disorders | PHILIP HICKEY, PH.D.
Psychiatry Still Doesn’t Get It
On 3-4 June, the Institute of Psychiatry in London hosted an international conference to mark the publication of DSM-5. On June 10, Sir Simon Wessely, a department head at the Institute, published a paper called DSM-5 at the IoP. The paper is a summary of the conference proceedings, and also, in many respects, a defense of DSM-5. The article touches on many issues that are central to the current anti-psychiatry debate, and for this reason, I thought it might be helpful to take a close look at the piece.
WHY IS DSM-5 CONTROVERSIAL?
Sir Simon expresses surprise that DSM-5 has been so controversial. He discusses this matter from various perspectives, but in my view he misses the essential point.
He writes: “The DSM is nothing more than a list of psychiatric disorders, accompanied by descriptions of disorders and explicit criteria for their diagnosis.”
It might be argued that this statement is true in the literal sense of the term, but it ignores the fact that the DSM is also (and perhaps more importantly) the primary source of legitimacy for the unproven assumption that all serious human problems are in fact illnesses, and are best “treated” by medical methods.
The contention that the DSM is nothing more than a list of psychiatric disorders is a bit like saying that Malleus Maleficarum (1487) is nothing more than a list of signs by which witches can be identified, and ignoring the fact that it was also the authoritative confirmation that witches really did exist and really did cause a great deal of mischief. For almost three centuries, Malleus Maleficarum served as the justification for murdering eccentric and otherwise unpopular women. In the same way, today DSM is used throughout America and other countries to justify and legitimize the drugging (sometimes forcibly) of millions of people, frequently with horrendous side effects.
But Sir Simon doesn’t seem to be aware of any of that.
Nor is this aspect of the DSM’s identity an accident. In 1952, when the first DSM was published, I don’t think it would be an exaggeration to say that psychiatry was a laughing stock among medical specialties. As the latter increasingly aligned themselves conceptually and practically with science, psychiatry wallowed in the decidedly unscientific notions of psychoanalytic theory and the brutal unvalidated “treatments” of the asylums.
Psychiatry desperately needed to get its act together and establish that it was a real medical specialty. It is arguable that this may have been a secondary agenda in 1952, but by 1968 – the year DSM-II was published – this aspect had become more urgent. There were two reasons for this. Firstly, the pharmaceuticals were coming on stream, and psychiatrists needed bona fide illnesses for which to prescribe these products. Secondly, behavior therapy was experiencing a great deal of success in the mental hospitals, especially with the more “challenging” cases, and was beginning to pose a significant challenge to psychiatric hegemony. By unequivocally medicalizing the presenting problems, psychiatry legitimized the widespread drugging of its clients, re-established its supremacy, and at the same time marginalized and subordinated behavior therapy.
The notion that all problem behaviors and emotions are illnesses is a spurious and unproven assumption, but it is an assumption that has served psychiatry (and incidentally their pharmaceutical allies) well for over four decades.
And that is why there has been so much controversy surrounding the publication of DSM-5. The negative press has arisen, not because there is anything strikingly new or different about DSM-5. The criticism stems rather from the fact that it is just more of the same. It’s the same lie being trotted out: that depression, misbehavior, mania, disruptiveness, temper tantrums, anxiety, etc., are real illnesses – just like diabetes. And that this lie is still being promoted despite four decades of failed research looking for the biological etiologies that would save this sorry theory.
In the meantime, the concept of mental illness is just another spurious assumption which would have been scrapped long ago but for the fact that it serves the interests of psychiatrists and their pharmaceutical allies.
The IoP conference could have addressed this – the central issue of the debate. And Sir Simon could have written about this. But instead, the matter was ignored.
EXPANSION OF DIAGNOSTIC ACTIVITY
Instead, Sir Simon wrote about the fact that the number of diagnoses has been quietly increasing, but that thankfully DSM-5 has reversed this trend. Does he seriously imagine that fewer people will be assigned psychiatric “diagnoses” under DSM-5 than under DSM-IV?
Sir Simon also concedes that there has occurred what he calls “psychiatric mission creep” – “the medicalization of the normal, the eccentric and the odd.” Bravo! But it’s still not the main issue. Medicalizing severe problems is just as spurious as medicalizing trivial problems.
Sir Simon goes on to reassure us that: “Concerns that the DSM-5 would continue in the inexorable march of medicalization by adding grief and bereavement to the list of human emotions that now required treatment were misplaced.” I find myself at a loss as to how he can possibly know that. Grief and bereavement are already being widely medicalized under DSM-IV, and this trend is almost certain to expand, given the specific easing of criteria in DSM-5.
Continuing on the topic of diagnostic expansion, Sir Simon writes:
“For most psychiatrists, claims that we are embarked on emotional world domination, seeking to extend our boundaries, populations and wallets further and further sounds hollow and frankly laughable when most face the most stringent cuts to services in a lifetime.”
This quote warrants some scrutiny. What Sir Simon is saying here is:
1. Our critics contend that we are pursuing emotional world domination. Ha, ha.
This is essentially an attempt to ridicule the opposition. Addressing our concerns openly and honestly would have been more productive.
2. The opposition say that we are seeking to extend our boundaries, populations, and wallets.
Psychiatrists have been, are, and apparently plan to continue extending their boundaries, populations, and wallets. And, with the help of pharma dollars, have been remarkably successful in these areas. Juxtaposing this statement with the world domination quip is a standard spin doctor trick, well-known to politicians.
3. The contentions of our opponents are hollow and laughable, because … get this … because our budgets are being cut due to governmental finance restrictions.
The fiscal restraints or otherwise of governments have no bearing on whether or not psychiatry has been pursuing an expansionist agenda. In fact, the psychiatry-pharma alliance has been consistently and successfully pursuing an expansionist agenda for the past 40 years, regardless of the state of the public coffers.
MARGINALIZING THE CRITICS
Sir Simon laments the fact that the media, “fired up” by DSM-5, are “dominated by a radical critique, questioning the legitimacy of psychiatry.”
Note the terms “fired up” and “radical”. Instead of responding in a rational and considered way to our criticisms, he’s attempting to portray us as revolutionary hotheads. And we have the audacity to question the legitimacy of psychiatry! Imagine!
Sir Simon also laments the fact that a UK psychologist used the occasion of the DSM-5 launch to say that all psychiatric diagnosis is wrong, and – listen to this – was not “shouted down,” but was actually allowed to air her views on a radio program! Can you imagine that? Daring to criticize psychiatry! And actually given air time!
COMMANDEERING THE CRITICISM
One of the basic tactics in political spin is commandeer-the-criticism. What’s involved is taking the opponent’s point, accepting it as if it were one’s own idea, but altering it just enough to work to one’s own advantage.
Here’s a nice example that comes near the end of Sir Simon’s article:
“No one can, and no one does, deny that the need to be kind, empathetic and understanding, to see all illness in its social context, to understand all illness as to how it affects the person. Far from being a “radical critique” let alone a mandate for the inevitable “paradigm shift” that our critics are calling for, that is merely a description of good psychiatry.”
The first sentence doesn’t close – but the meaning of the quote is clear: we’re good guys; we’re kind, empathetic, and understanding. We see all illness in its social context and in the effect it has on the person. This isn’t a radical critique. This doesn’t warrant the paradigm shift that these bounders are demanding. This is just good psychiatry.
So all the criticisms which we mental illness deniers direct at psychiatry are just nonsense; just so much wasted effort because … psychiatry is already there! Psychiatry doesn’t need to change!
But notice how the word “illness” got sneaked in twice. And that, as Sir Simon should know, is where the paradigm shift is needed: the recognition that the problems psychiatry is “diagnosing” and drugging are not illnesses. If he has proof to the contrary, this might have been a good place to set it out.
Sir Simon’s final paragraph is a gem of irrelevance. I must quote it in full:
“The reception afforded DSM-5 has reminded us how we sometimes look to the outside world and it is not always pretty. The charge that DSM itself is a Big Pharma fuelled exercise to open new markets for the sale of drugs is not helped when it becomes clear that some of the biggest names in psychiatry have been less than transparent in their financial dealings. Sadly the APA only gives further ammunition to the critics when it charges an exorbitant price for an almost unreadable book of marginal relevance to the mental health challenges facing most of the world. But the public relations disaster could still be turned into a triumph if the APA joined the open access movement sweeping across the world of scientific publishing and agreed to make if not DSM-5, then at least DSM 6, free to all. But I am not holding my breath.”
He mentions the accusation that the DSM is essentially a pharmaceutical instrument to sell more drugs. Now there’s an interesting thought that might have warranted some debate. But no, we move on.
Then he mentions that some of the “biggest names” in psychiatry have been “less than transparent” in their financial dealings. Some of us might have said “corrupt.”
And while we’re on the subject of corruption coupled with big names in psychiatry, let us remember the Sir Simon’s own Institute of Psychiatry honored Charles Nemeroff, MD by inviting him to speak at the opening of their new Centre for Affective Disorders on June 17. In case you’re not familiar with Dr. Nemeroff’s history, here’s an extract from Wikipedia.
“Nemeroff’s undisclosed ties to drugmakers and under-reported incomes from them have raised questions about conflict of interest. Following a Congressional Investigation led by Senator Charles Grassley of the Senate Finance Committee, Nemeroff was found to be in violation of federal and university regulations and resigned as chair of the psychiatry department at Emory University. He was also forbidden by Emory to act as an investigator or co-investigator on National Institutes of Health grants for at least two years. Nemeroff has moved to Florida and become the chair of psychiatry at the University of Miami.
According to the Annals of Neurology, the court documents released as a result of one of the lawsuits against GSK in October 2008 indicated that GSK ‘and/or researchers may have suppressed or obscured suicide risk data during clinical trials’ of paroxetine. ‘Charles Nemeroff, former Chairman of the Department of Psychiatry at Emory University, was the first big name ‘outed’ … In early October, Nemeroff stepped down as department chair amid revelations that he had received over $960,000 from GSK in 2006, yet reported less than $35,000 to the school. Subsequent investigations revealed payments totaling more than $2.5 million from drug companies between 2000 and 2006, yet only a fraction was disclosed’.”
Any reputable profession, I suggest, would have ostracized, and probably disbarred, Dr. Nemeroff. But not psychiatry. In psychiatry, that kind of corruption draws honors and accolades. Sir Simon might have written about that.
He might also have explained to us why his institute hosted a conference to mark the publication of DSM-5 if it is – as he claims – “…a book of marginal relevance…”
Then the insult to end all insults. The APA, Sir Simon writes, has given ammunition to psychiatry’s opponents by over-charging for DSM-5.
Does he seriously imagine that whether DSM-5 costs $10 or $200 makes a nickel’s worth of difference? Does he imagine that if DSM-5 had been less expensive that these protests would not have happened? Is he so out of touch with the fundamental flaws in his chosen profession that he believes that the cost of this book is even on our radar?
And – he tells us – the public relations disaster could have been turned around if the APA had distributed the book free!
And remember, dear readers, Sir Simon is an eminent psychiatrist.
June 26, 2014
Professor Sir Simon Wessely is a British psychiatrist who works at the Institute of Psychiatry, King’s College, London. He is also the new President of the Royal College of Psychiatrists, and in that capacity, he recently wrote his first blog, titled, appropriately enough, My First Blog (May 24, 2014). The article is essentially a perusal of, and commentary on, the program for the RCP’s Annual Congress, about which Sir Simon expresses considerable enthusiasm. He also engages in a little cheerleading.
” . . . We [the RCP] are the most democratic of colleges. We welcome the views of patients and carers . . . “
This statement struck me as odd, because it’s not so long ago (December 20, 2013) that I read a post by British psychiatrist Joanna Moncrieff, Psychiatry has its head in the sand: Royal College of Psychiatrists rejects discussion of crucial research on antipsychotics. In this article, Dr. Moncrieff describes how she approached the RCP 2014 Conference planning committee, and asked that a symposium on “Re-evaluating antipsychotics – time to change practice” be included in the program. To her surprise, this proposal was rejected on the grounds that there were too many competing suggestions.
Dr. Moncrieff’s proposal was based on two ground-breaking studies (Ho, BC, Andreasen, NC, et al; and Wunderink L, et al.), both of which, at the very least, raise serious concerns about psychiatry’s current use of neuroleptic drugs. This certainly seems important, but in fairness to the RCP, perhaps there were topics of even greater moment, and Dr. Moncrieff’s suggestion simply couldn’t be accommodated.
Curious as to what these topics might be, I took a look at the conference schedule, and found a few entries that might conceivably have been nudged aside for Dr. Moncrieff’s proposed symposium. These include:
- Developing your teaching portfolio
- Succeeding as a new consultant
- Leadership development for the jobbing psychiatrist – what we all need to know
- Private practice
- Advanced communication skills for public engagement
- Making parity a reality
- How to get into Academic Psychiatry
And just possibly:
- Debate – Hamlet’s Ophelia: was it suicide?
In fairness to Prof. Wessely, he probably didn’t have much hand in the design of the program. (He’s the incoming President.) But he must have been aware of the College’s rejection of Dr. Moncrieff’s suggestion, and he might have expressed some regrets about this matter rather than asserting platitudinously that the RCP is the “most democratic of colleges,” that welcomes the ” . . . views of patients and carers.”
Anyway, there’s lots more cheerleading in Prof. Wessely’s post, including:
” . . . Psychiatry, like all branches of medicine . . . “
“We do not shy away from controversy . . . “
“[Attenders] will be left in no doubt about the prevalence and public health impact of the illnesses that lie at the heart of psychiatry.”
” . . . The endless fascination of psychiatry.”
” . . . The state of psychiatry is good.”
” . . . The importance of psychiatry in the modern health service.”
This is the kind of thing that we’ve come to expect from organized psychiatry in recent years, and it adds little to the current debate. But there was one statement in Dr. Wessely’s article that I would like to address in more detail:
“Any lingering doubts that psychiatry is not scientific will hopefully be dispelled, since the science of psychiatry is on constant display from the start to the finish of the conference.”
I think it would be accurate to say that the most fundamental principle in modern psychiatry is that all significant problems of thinking, feeling, and/or behaving are illnesses, caused by chemical imbalances or other putative neurological anomalies. The first part of this principle has been enshrined explicitly in the DSM’s definition of a mental disorder since DSM-III, and implicitly since DSM-II. The second part has been promoted vigorously by psychiatry for decades. This proposition is fundamental in the sense that from it, everything that psychiatry does, and stands for, flows.
The statement is also an assumption, proof of which has never been provided. Nor is the assumption self-evident. In fact, as those of us on this side of the issue have contended for decades, there are more parsimonious, and more helpful, ways to conceptualize these problems. The inattention, hyperactivity, and impulsivity characteristic of the condition labeled ADHD, for instance, can be conceptualized simply as a failure on the child’s part to acquire certain skills and habits that are considered appropriate for his age. Depression can be conceptualized as a normal response to loss, or to an unfulfilling, treadmill kind of life. And so on.
In science, of course, it’s perfectly OK to start off with an assumption (scientists call them hypotheses), and to design and execute experiments/studies to test their truth or falsity. But psychiatry has never established the truth of its core assumption. In fact, all attempts in this area have failed! So – instead of debunking this cherished assumption, as real scientists would have done, they have simply assumed it to be true, and have steadily promoted its acceptance through endless repetition, manipulation of the media, and vigorous condemnation of critics.
Then, to create the impression of science, they have conducted vast numbers of studies and trials, all designed to test various peripheral matters, but all ultimately depending for their validity on the core assumption. This isn’t science. It is nonsense, dressed up as science.
To illustrate this, let’s consider another assumption that is nonsensical: that all criminal activity is ultimately the result of alien abduction during infancy. Let’s suppose that I, basking in the narcissistic, error-prone grandiosity of which supporters of psychiatry sometimes accuse me, subscribe to this belief. Let’s further suppose that, to promote and study this core assumption, I start a new scientific discipline, which for want of a better term, I’ll call E.T.ology.
So I build a website, and attract a following, and we set about conducting E.T.ology studies to support our contention. We produce numerous papers showing that crime is most prevalent in areas where UFO sightings are most frequent. We demonstrate, through various statistical analyses, that criminals received less than average parental supervision during infancy, rendering them more vulnerable to alien abduction. And so on. And we publish these studies in our very own Journal of E.T.ology. We also speculate as to what the aliens actually do to their victims to instill the seeds of future lawlessness, and in this regard our scientists use colorful pictures of criminals’ brains to demonstrate chemical imbalances, neural circuitry anomalies, and other evidence of tampering. We develop and publish a manual for the early detection of abduction victims. The manual lists items like: failure to conform to age-appropriate social norms, deceitfulness, impulsivity, irritability and aggressiveness, recklessness, spitefulness, defiance, etc.
We have impressive-looking graphs and tables in our journal articles. We use statistical terms like correlation-coefficient, standard deviation, confidence interval, risk ratios, etc., with an easy familiarity, and we dismiss the protests of dissenting voices as the bigoted railings of anti-science deniers. We construct a sophisticated propaganda apparatus, and in our annual conferences, we have sessions on “advanced communication skills for public engagement” and related topics. We develop close ties with politicians from all branches of government, and from all corners of the political spectrum, and we advocate relentlessly for the creation of “space-shields” to protect infants from these alien invaders, who are robbing our children of their future.
We also, and entirely coincidentally, receive considerable financial support from the manufacturers of space-shield technology.
In this analogy it’s easy to see that what we have created is not science, but a travesty. It is a travesty because we will not subject our core assumption to serious scrutiny, and because we routinely allow our commitment to this assumption to direct and taint our discussions and our research efforts. What we have built is a sandcastle which, however impressive it may seem, has no defense against a flowing tide, and must ultimately collapse.
Similarly, psychiatry, despite decades of failed attempts at validation, continues to cling to its core assumption – that all significant problems of thinking, feeling, and/or behaving are illnesses. This spurious assumption underlies, drives, and ultimately invalidates everything they do, and stand for.
It is also the fundamental justification for their existence as a profession. If the core assumption were to go away, as eventually it must, then psychiatry, as it presently operates, will cease to have any relevance or purpose, and will simply collapse. In fact, it would have collapsed long ago, but for the massive, ongoing financial support that it receives directly and indirectly from its symbiotic, and incidentally corrupt, relationship with pharma.
So when Professor Wessely writes that ” . . . the science of psychiatry is on constant display from the start to the finish of the conference,” he’s referring to the sandcastle. He’s admiring the well-sculpted towers and turrets, the arched windows, and the pennants streaming in the sea breeze. But he’s ignoring the fact that the edifice, of which he is so proud, has no foundation. And he also, apparently, hasn’t noticed that the tide is coming in.
* * * * *
This article was first published on Philip Hickey’s website, Behaviorism and Mental Health